Is Hospice nursing "easier"?

lifelearningrn, BSN, RN · Nov 23, 2014

I wouldn't say any form of nursing is "easier" than another... and I suppose it also depends on what one considers easy. You're going to learn really quickly in nursing school, that none of is easy. If worrying a patient might pass away on your watch is a major source of anxiety for you, than I suppose knowing that is the expected outcome might bring you some ease. There are a lot of challenges to hospice nursing, like any other.

RNGrad2006 · Nov 24, 2014

i have been told that hospice nursing is harder for those with less experience in life. Dealing with end of life issues can be very stressful in its own way. Even with a more expected death it does not make it easy. Just my 2 cents. I worked for a hospice company for a while but on the Palliative Care side and even that had its tough moments since we transition people to hospice. It can be so sad at times....but rewarding as well.

mgrenwic · Nov 24, 2014

I can relate to what you said;I am not a spring chicken so unfortunately death has been a significant part of my life.

It actually was my inspiration to leave finance and pursue nursing.

I was fortunate to be around some excellent nurses, especially toward the end.

I guess in my mind coming in knowing you very well may lose a patient that day is somehow comforting - not sure that makes sense. I guess in my mind you go into the day kind of knowing what to expect.

heron, ASN, RN · Nov 24, 2014

Hello,
I was recently accepted to nursing school and have turned my focus to where I might want to work after school.
I was wondering if Hospice nursing is "easier" in a sense.

Nope.

Especially if you don't yet have the knowledge base and assessment skills to understand the natural course of a life-limiting illness, its associated symptoms through the terminal stages and how to manage them.

Bedside, the care can get just as "heavy" - in terms of physical work - as with any acutely ill total care patient.

Furthermore, the "unit of care" in hospice is the patient AND his/her family of choice ... you have way more responsibilities regarding family dynamics than you do elsewhere in health care.

Nienna Celebrindal · Nov 24, 2014

Death can be ugly and stressful and require quite a bit of care so no definitely not. It's very emotional.

but you do get to spend meaningful time with patients and families and guide people through a difficult part of life.

I would highly recommend not going straight to hospice. You absolutely need life experience to draw off of. It's a lot of psychological and emotional support.

I do love hospice though I did it for 2 years and will probably go back in the future.

TheCommuter, BSN, RN · Nov 24, 2014

I would not say that hospice nursing is easier. However, it entails far less liability than other nursing specialties because all of your patients will have terminal prognoses, and the vast majority will have DNR orders.

It is very unlikely that a hospice physician or nurse will be deposed by a plaintiff's attorney three years after a patient's death has transpired.

mgrenwic · Nov 24, 2014

I would not say that hospice nursing is easier. However, it entails far less liability than other nursing specialties because all of your patients will have terminal prognoses, and the vast majority will have DNR orders.
It is very unlikely that a hospice physician or nurse will be deposed by a plaintiff's attorney three years after a patient's death has transpired.

Very interesting input - wouldn't have thought of this aspect. Thank you.

westieluv · Nov 24, 2014

I've done both inpatient hospice and home hospice nursing. Inpatient is easier in the sense that it is much like working LTC only without the ridiculous med passes and everyone is at the end stage of life. Not saying it is easy, because there is still a lot of physical work like lifting patients, etc. sometimes and dealing with families can be very taxing and sometimes even nerve wracking (the time that a dying patient did NOT want to see her son and he was not allowed in the facility but kept lurking around outside at night trying to slip in whenever someone opened the door, stuff like that).

Home hospice is not easy at all. First there is a ton of driving in all kinds of weather, Then there is hauling your overstuffed bag into the patient's home. You also keep a large box of supplies in your trunk, just in case, and you never know what you may need. You may go in and find the patient sleeping and the family all gone out somewhere except, say, one kindly sister, and then you may walk in and the patient is hallucinating, vomiting blood, or any number of other things, the family members are all there getting on each others' nerves or yelling at each other, the dog's barking, etc. They all look to you for calmness and reassurance, and they expect you to know exactly what to do in any situation, because often times they are scared, angry, upset, and grieving and you are the one who is supposed to be able to fix everything. The hours can be very long, because you know when it is and is not appropriate to leave a particular situation, even when you feel like leaving and have other things to do. There can be hard physical work, because if a dying patient is lying on the sofa and has in episode of incontinence, the family may help, but they are going to expect you to do the bulk of the work of cleaning the patient up.

I once went into a home late in the evening when I was doing after hours on-call hospice nursing, and there was a very elderly lady lying on a sofa dressed like she was going to church; pantyhose, undergarments, slip, polyester dress with a zipper up the back, and all kinds of jewelry like necklaces, rings, etc. She had been incontinent of stool, and there was stool and urine on her and her clothing from head to toe, smeared in her rings on her hands...basically everywhere. The family told me that they wanted her cleaned up and changed into a fresh nightgown and underwear for "her passing time", and not a one of them lifted a finger to help me. Not one of my finer moments in nursing and really not the norm in hospice nursing, but I'm just giving you and idea what you may walk into.

Hospice nursing can be very rewarding, but it is not easy.

caliotter3 · Nov 25, 2014

I find hospice nursing to be, on a visit to visit basis, more taxing than regular home care. There is more emotional tension, often the family never leaves the room, or you could have family members becoming inebriated or arguing with one another. At one home, I had to keep an eye on the patient's morphine. The daughter told me her aunt was an addict and would try to get her hands on the medicine, she had already been successful in stealing one bottle. Sure enough, when she came, she was grilling me about the whereabouts of the "pain medicine". And then when the patient passes, you have to deal with providing even more emotional support. I never left a hospice home without great feelings of fatigue afterwards.

PomMom65 · Nov 27, 2014

I went straight into Hospice nursing from school. I had a greater learning curve than most. I work with wonderful nurses that have taught me a lot. I work on an inpatient unit so I am not out there alone. I am also 50 years old and have life experience dealing with all types of people. I cannot tell you if it is easier because I have nothing to base that from. However, I will say that if you choose home hospice you will be out there by yourself, you have a lot of autonomy and you never know what you are walking into. You will encounter situations where family members are not on the same page with regard to the patient. You will have family members that are not realistic about the patient's prognosis. You will hear "If they would just eat and get stronger"..... You will find that your professional judgement is that the patient should be medicated for pain but the family wants them lucid so they refuse meds. We admitted a man last night and his son, who is a physician, asked me how we were going to "off his father". With that said, you will have people that are grateful for the care you provide to them and their families. You will have the honor of being with someone as they take their last breath. I find it more rewarding than stressful. I love my job and I feel blessed to have it. Please remember that not all hospice patients are elderly. I have taken care of a 14 year old, a 19 year old, women my own age, men and women with little kids. Sometimes you get close to these people and then see them come back onto the unit and pass away. You grieve. You laugh. You cry.

Kitty Hawk, ADN, RN · Nov 28, 2014

I don't know that it's accurate to say that because they're on hospice, they're dying and you know what you're walking into. We have some pt's that fit that description of days or weeks but we also have ones that have been on our service for 2 years and others somewhere in between that have goals that you help them attain so from that aspect of problem solving and making a difference it's awesome. We are Christian based so that may be the difference. As all of us there literally knew God called us there.

All in all it's been the best nursing job that I've had, I have a wonderful team and the autonomy is great. I truly feel blessed to have this job.

Granted it's going to depend on your company, but some of the posters with out of the norm experiences, not every hospice is run the same. For example for our on call, we would not go to a patient's home after hours for incontinence, the family is the primary caregiver so it's their responsibility of taking care of that patient when we aren't there including cleaning their loved one up if they are incontinent. We do not go out on call for anything other than emergencies which are foley cath issues (however if it's a matter that it came out and pt can still void around it, we instruct to place towels and someone will be out in the morning) for pain and sob we instruct how to use the meds that come in their e kit. If there's no resolution we may go out and then likely admit the pt to one of our in patient units. We go out to pronounce as well. We trouble shoot as much as possible over the phone. We do take turns triaging the calls but we also have a really good system and you're never alone, there's always someone else to call if need be. Even on the weekends we are stacked with others and we're more back up to the regular weekend crew.

It's part of our teaching when we bring someone one to tell the family not to disappear when the aide comes to do the bath etc...that the family needs to learn how to care for them because we are not going to be there when they have that huge BM and they need to know how to handle it. We know we're doing our job when the family is able to handle things (for the most part) on their own on the weekends. The job is very rewarding because you are teaching the family how to care for their loved one at a most intimate time in their lives.